About the Award: The Everyday Safety Hero award provides Hoosier employers with the opportunity to nominate an individual who has championed workplace safety and health excellence in their respective workplace.
The nominee is not required to be a safety or health professional, in fact, this award looks to acknowledge and recognize the contributions, participation, and impact that a front-line employee plays in Hoosier workplace safety and health.
Nominators must provide information to support the award nomination by describing the individual’s achievements, contributions, or impact in workplace safety and health. Please consider contribution(s) in one or more of the following areas:
- Safety and Health Leadership-Leadership in advocacy of worker safety and health initiatives which are above and beyond the traditional scope of one’s position.
- Innovationin Safety and Health -Development of innovative practices and procedures that reduce occupational hazards or risk.
- Promotion of Teamwork-Encouragement of team safety awareness, communications, and advocacy of safe and healthy workplace.
- Hazard Identification and Correction-Encouragement of improved safety self-audits, incident reporting, and other practices which lead to hazard reduction.
The 2017 award recipients will be notified in advance of the Governor’s Workplace Safety Awards Luncheon. The Luncheon will be held during the annual Indiana Safety and Health Conference & Expo, on Thursday, March 2, 2017. The conference partners will recognize and celebrate the successes of the Governor’s Workplace Safety Awards recipients. The annual conference will be held February 28 – March 2, 2017 at the Indiana Convention Center in downtown Indianapolis. Visit for more information or to register for the conference.
Directions: Please tell us about your Everyday Safety Heroby completing and submitting the form below. You may type directly into this form. Submissions for consideration are due on or before Wednesday, January 18, 2017. See submission instructions on the last page of this form.
Access to Public Records Request (APRA)
Nominations may be subject to Access to Public Records Request (APRA). Please do not include personal, confidential, or trade secret information in your nomination.
What is YourEveryday Safety Hero’sName?
What is YourEveryday Safety Hero’sTitle?
Nominated By / Nominator’s Title
Nominator’s Phone Number (Include Area Code) / Nominator’s Email Address
Organization’s Website
Organization’s Street Mailing Address
City / State
Indiana / Zip Code
Please list your Everyday Safety Hero’sname as it should appear on the award if he or she is selected as an award recipient.
In 1,000 words or less, please tell us how your Everyday Safety Hero has positively impacted the safety and health of your workplace.
Submission Instructions: All Everyday Safety Heronomination forms must bereceived by the Indiana Chamber of Commerce by 5 p.m., Wednesday, January 18, 2017.
To submit the completed nomination form, you may email or mail/hand-deliver to:
2017 Everyday Safety Hero Nomination
Attention: Ms. Jesse Brothers
Indiana Chamber of Commerce
115 West Washington Street, Suite 850S
Indianapolis, Indiana 46204